Focusing on Appearance

Most of us spend time in front of the mirror checking our appearance. Some people spend more time than others, but taking care of our bodies and being interested in our appearance is natural.

How we feel about our appearance is part of our body image and self-image. Many people have some kind of dissatisfaction with their bodies. This can be especially true during the teen years when our bodies and appearance go through lots of changes.

Although many people feel dissatisfied with some aspect of their appearance, these concerns usually don't constantly occupy their thoughts or cause them to feel tormented. But for some people, concerns about appearance become quite extreme and upsetting.

Some people become so focused on imagined or minor imperfections in their looks that they can't seem to stop checking or obsessing about their appearance. Being constantly preoccupied and upset about body imperfections or appearance flaws is called body dysmorphic disorder.

What Is Body Dysmorphic Disorder?

Body dysmorphic disorder (BDD) is a condition that involves obsessions, which are distressing thoughts that repeatedly intrude into a person's awareness. With BDD, the distressing thoughts are about perceived appearance flaws.

People with BDD might focus on what they think is a facial flaw, but they can also worry about other body parts, such as short legs, breast size, or body shape. Just as people with eating disorders obsess about their weight, those with BDD become obsessed over an aspect of their appearance. They may worry their hair is thin, their face is scarred, their eyes aren't exactly the same size, their nose is too big, or their lips are too thin.

BDD has been called "imagined ugliness" because the appearance issues the person is obsessing about usually are so small that others don't even notice them. Or, if others do notice them, they consider them minor. But for someone with BDD, the concerns feel very real, because the obsessive thoughts distort and magnify any tiny imperfection.

Because of the distorted body image caused by BDD, a person might believe that he or she is too horribly ugly or disfigured to be seen.

Behaviors That Are Part of BDD

A compulsion is something a person does to try to relieve the tension caused by the obsessive thoughts. For example, someone with obsessive thoughts that her nose is horribly ugly might check her appearance in the mirror, apply makeup, or ask someone many times a day whether her nose looks ugly. These types of checking, fixing, and asking are compulsions.

Somebody with obsessions usually feels a strong or irresistible urge to do compulsions because they can provide temporary relief from the terrible distress. The compulsions seem like the only way to escape bad feelings caused by bad thoughts. Compulsive actions often are repeated many times a day, taking up lots of time and energy.

Avoidance behaviors are also a part of BDD. A person might stay home or cover up to avoid being seen by others. Avoidance behaviors also include things like not participating in class or socializing, or avoiding mirrors.

With BDD, a pattern of obsessive thoughts, compulsive actions, and avoidance sets in. Even though the checking, fixing, asking, and avoiding seem to relieve terrible feelings, the relief is just temporary. In reality, the more someone performs compulsions or avoids things, the stronger the pattern of obsessions, compulsions, and avoidance becomes.

After a while, it takes more and more compulsions to relieve the distress caused by the bad thoughts. A person with BDD doesn't want to be preoccupied with these thoughts and behaviors, but with BDD it can seem impossible to break the pattern.

What Causes BDD?

Although the exact cause of BDD is still unclear, experts believe it is related to problems with serotonin, one of the brain's chemical neurotransmitters. Poor regulation of serotonin also plays a role in obsessive compulsive disorder (OCD) and other anxiety disorders, as well as depression.

Some people may be more prone to problems with serotonin balance, including those with family members who have problems with anxiety or depression. This may help explain why some people develop BDD but others don't.

Cultural messages can also play a role in BDD by reinforcing somebody's concerns about appearance. Critical messages or unkind teasing about appearance as someone is growing up may also contribute to a person's sensitivity to BDD. But while cultural messages, criticism, and teasing might harm someone's body image, these things alone usually do not result in BDD.

It's hard to know exactly how common BDD is because most people with BDD are unwilling to talk about their concerns or seek help. But compared with those who feel somewhat dissatisfied with their appearance, very few people have true BDD. BDD usually begins in the teen years, and if it's not treated, can continue into adulthood.

How BDD Can Affect a Person's Life

Sometimes people with BDD feel ashamed and keep their concerns secret. They may think that others will consider them vain or superficial.

Other people might become annoyed or irritated with somebody's obsessions and compulsions about appearance. They don't understand BDD or what the person is going through. As a result, those with BDD may feel misunderstood, unfairly judged, or alone. Because they avoid contact with others, they may have few friends or activities to enjoy.

It's extremely upsetting to be tormented by thoughts about appearance imperfections. These thoughts intrude into a person's awareness throughout the day and are hard to ignore. People with mild to moderate symptoms of BDD usually spend a great deal of time grooming themselves in the morning. Throughout the day, they may frequently check their appearance in mirrors or windows. In addition, they may repeatedly seek reassurance from people around them that they look OK.

Although people with mild BDD usually continue to go to school, the obsessions can interfere with their daily lives. For example, someone might measure or examine the "flawed" body part repeatedly or spend large sums of money and time on makeup to cover the problem.

Some people with BDD hide from others, and avoid going places because of fear of being seen. Spending so much time and energy on appearance concerns robs a person of pleasure and happiness, and of opportunities for fun and socializing.

People with severe symptoms may drop out of school, quit their jobs, or refuse to leave their homes. Many people with BDD also develop depression. Those with the most severe BDD might even consider or attempt suicide.

Many people with BDD seek the help of a dermatologist or cosmetic surgeon to try to correct appearance flaws. But dermatology treatments or plastic surgery don't change the BDD. Those who find cosmetic surgeons willing to perform surgery are often not satisfied with the results. They may find that even though their appearance has changes, the obsessive thinking is still present, and they begin to focus on some other imperfection.

Getting Help for BDD

If you or someone you know has BDD, the first step is recognizing what might be causing the distress. Many times, people with BDD are so focused on their appearance that they believe the answer lies in correcting how they look, not with their thoughts.

The real problem with BDD lies in the obsessions and compulsions, which distort body image, making someone feel ugly. Because people with BDD believe what they're perceiving is true and accurate, sometimes the most challenging part of overcoming the disorder is being open to new ideas about what might help.

BDD can be treated by an experienced mental health professional. Usually, the treatment involves a type of talk therapy called cognitive-behavioral therapy. This approach helps to correct the pattern that's causing the body image distortion and the extreme distress.

Treatment for BDD takes time, hard work, and patience. It helps if a person has the support of a friend or loved one. If someone with BDD is also dealing with depression, anxiety, feeling isolated or alone, or other life situations, the therapy can address those issues, too.

Body dysmorphic disorder, like other obsessions, can interfere with a person's life, robbing it of pleasure and draining energy. An experienced psychologist or psychiatrist who is knowledgeable about BDD can help break the grip of the disorder so that a person can fully enjoy life.